Representing older people: towards meaningful images of the user in design scenarios

Designing for older people requires the consideration of a range of difficult and sometimes highly personal design problems. Issues such as fear, loneliness, dependency, and physical decline may be difficult to observe or discuss in interviews. Pastiche scenarios and pastiche personae are techniques that employ characters to create a space for the discussion of new technological developments and as a means to explore user experience. This paper argues that the use of such characters can help to overcome restrictive notions of older people by disrupting designers' prior assumptions. In this paper, we reflect on our experiences using pastiche techniques in two separate technology design projects that sought to address the needs of older people. In the first case pastiche scenarios were developed by the designers of the system and used as discussion documents with users. In the second case, pastiche personae were used by groups of users themselves to generate scenarios which were scribed for later use by the design team. We explore how the use of fictional characters and settings can generate new ideas and undermine rhetorical devices within scenarios that attempt to fit characters to the technology, rather than vice versa. To assist in future development of pastiche techniques in designing for older people, we provide an array of fictional older characters drawn from literary and popular culture.</p

Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery

Background. The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods. In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman’s two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results. During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (p<0.001). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p<0.001) and reversed to baseline values post HIPEC. Conclusion. Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP

Don't Let Primary Care Patients Slip through the Nets

Nearly 7 million patients might have been subject to a general practice error in the past year. With new models of care proposed, Sukhmeet Panesar and colleagues urge GPs to have a greater awareness of patient safet

Paramedic utility in screening patients who present to Emergency Medical Services and who may benefit from an Advance Care Plan: A mixed methods study with explanatory sequential design

We used a two phased mixed methods study with an explanatory sequential design to understand how frequently paramedics attend patients who, on paramedic assessment with the Gold Standards Framework Proactive Identification Guidance, are end-of-life and have advance care planning. We subsequently explored paramedic views on paramedic screening of patients to assess if they are end-of-life and onward referral to their General Practitioner for advance care planning.Paramedics screened and recorded 14.9% of patients as end-of-life and 44.3% of these patients were assessed to have no advance care plan in place. Where paramedics screened patients and they did have an advance care plan in place, 36.8% had only a Do Not Attempt Cardiopulmonary Resuscitation. Paramedics found using the Gold Standards Framework Proactive Identification Guidance to screen patients for end-of-life status useful and straightforward and considered themselves well placed to complete this task. Future research is required to address the practicalities of implementing a paramedic screening and referral tool for end of life care that results in the intended outcome of supporting effective advance care planning

Scenario-based requirements elicitation for user-centric explainable AI

Explainable Artificial Intelligence (XAI) develops technical explanation methods and enable interpretability for human stakeholders on why Artificial Intelligence (AI) and machine learning (ML) models provide certain predictions. However, the trust of those stakeholders into AI models and explanations is still an issue, especially domain experts, who are knowledgeable about their domain but not AI inner workings. Social and user-centric XAI research states it is essential to understand the stakeholder’s requirements to provide explanations tailored to their needs, and enhance their trust in working with AI models. Scenario-based design and requirements elicitation can help bridge the gap between social and operational aspects of a stakeholder early before the adoption of information systems and identify its real problem and practices generating user requirements. Nevertheless, it is still rarely explored the adoption of scenarios in XAI, especially in the domain of fraud detection to supporting experts who are about to work with AI models. We demonstrate the usage of scenario-based requirements elicitation for XAI in a fraud detection context, and develop scenarios derived with experts in banking fraud. We discuss how those scenarios can be adopted to identify user or expert requirements for appropriate explanations in his daily operations and to make decisions on reviewing fraudulent cases in banking. The generalizability of the scenarios for further adoption is validated through a systematic literature review in domains of XAI and visual analytics for fraud detection

A Televised, Web-Based Randomised Trial of an Herbal Remedy (Valerian) for Insomnia

BACKGROUND: This trial was conducted as part of a project that aims to enhance public understanding and use of research in decisions about healthcare by enabling viewers to participate in research and to follow the process, through television reports and on the web. Valerian is an herbal over-the-counter drug that is widely used for insomnia. Systematic reviews have found inconsistent and inconclusive results about its effects. METHODS: Participants were recruited through a weekly nationally televised health program in Norway. Enrolment and data collection were over the Internet. 405 participants who were 18 to 75 years old and had insomnia completed a two week diary-keeping run-in period without treatment and were randomised and mailed valerian or placebo tablets for two weeks. All participants and investigators were blind to treatment until after the analysis was completed. FINDINGS: For the primary outcome of a minimally important improvement in self-reported sleep quality (> or = 0.5 units on a 7 point scale), the difference between the valerian group (29%) and the placebo group (21%) was not statistically significant (difference 7.5%; 95% CI-0.9 to 15.9; p = 0.08). On the global self-assessment question at the end of the treatment period 5.5% (95% CI 0.2 to 10.8) more participants in the valerian group perceived their sleep as better or much better (p = 0.04). There were similar trends favouring the valerian group for night awakenings (difference = 6.0%, 95% CI-0.5 to 12.5) and sleep duration (difference = 7.5%, 95% CI-1.0 to 16.1). There were no serious adverse events and no important or statistically significant differences in minor adverse events. INTERPRETATION: Based on this and previous studies, valerian appears to be safe, but with modest beneficial effects at most on insomnia compared to placebo. The combined use of television and the Internet in randomised trials offers opportunities to answer questions about the effects of health care interventions and to improve public understanding and use of randomised trials. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN72748991